A team of stroke researchers who studied dietary habits of more than 2,500 New York City residents say that drinking diet soda may increase the risk of heart attacks and strokes.

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LOS
ANGELES — Wednesday, Feb. 9, 2011 — Drinking diet soda
— but not regular soda — was associated with a greater risk of stroke,
heart attack or death from vascular causes in a study of older residents of
neighborhoods in northern Manhattan.

Drinking diet soda
every day was associated in 48 percent increase in risk of heart attack or
stroke compared with same-aged people who didn’t drink diet sodas, said to Dr. Hannah
Gardener, ScD, of the University of Miami in Florida.

There was no such
association for less-frequent consumption of diet soda or for any level of
regular soda consumption.

Gardener reported
the findings during the opening day of the American Stroke Association’s
International Stroke Conference here.

Gardener
acknowledged some limitations of the study, including the use of self-reported
dietary data at a single time point, and concluded that the findings are “too
preliminary to suggest any dietary advice.”

“If and only if the
results are confirmed can we suggest that diet soda may not be an optimal
substitute for sugar-sweetened beverages, which have been shown to have various
health consequences,” she said.

Doctors contacted
by ABC News and MedPage Today
were also hesitant to declare diet sodas the next great health risk, with
many attributing the increased vascular risk to other dietary factors that were
not measured in the study, such as the types of foods contributing to the total
caloric intake.

“Unfortunately, it
may be that individuals with poor dietary habits do resort [to] some kind of
calorie balancing and continue to eat high-calorie sweet foods but reduce their
‘guilt’ by drinking diet soda,” Dr. Howard Weintraub, clinical director of the NYU Center for the
Prevention of Cardiovascular Disease, wrote in an e-mail.

The study “adds to
the growing evidence of an association between diet sodas and cardiovascular
disease,” according to Dr. Cam Patterson, a cardiologist at the University of
North Carolina at Chapel Hill.

But, he added,
that, although the association cannot be ignored, it is too early to interpret
what it means.

“People need to
know about this, but it is important for everyone to realize that no general
guidelines should be derived from these types of observational studies,”
Patterson wrote in an e-mail.

“I’ll continue to
pack a diet soda with my lunch, but I’ll look more carefully at what else is in
my lunch box and I’ll pay more attention to what I’m doing while I’m drinking
my diet soda.”

Gardener and her colleagues analyzed data from the Northern Manhattan
Study (NOMAS), which includes individuals older than 40 living in New York
City.

The current
analysis included 2,564 participants. Their mean age was 69; about half were
Hispanic, one-fifth were white, and one-quarter were black.

Based on a food
frequency questionnaire completed at baseline, 35 percent of the cohort did not
drink either regular or diet soda.

Through an average
follow-up of more than 9 years, there were 559 incident vascular events,
including 212 strokes, 149 heart attacks, and 338 vascular deaths.

After adjustment
for demographic and behavioral and vascular risk factors — including BMI —
there was an increased risk of having a vascular event with daily diet soda
consumption, but no other levels of consumption of diet or regular soda.

Commenting on the
findings, Dr. Christopher Cannon, of Brigham and Women’s Hospital in Boston,
pointed out, however, that the number of participants who drank diet soda daily
was small — 116 — and that the lack of an association with regular soda
consumption was at odds with previous studies.

“This suggests that
the finding may be spurious, and needs confirmation in a much larger group of
patients,” he wrote in an e-mail.

Gardener agreed
that confirmation was needed before drawing any definitive conclusions, with
further studies that focus on a younger population with more diet soda
consumption and that collect diet information at multiple time points.

She and her
colleagues also examined the relationship between dietary
sodium intake and stroke in the NOMAS cohort.

Although the
American Heart Association recommends consuming less than 1,500 mg a day, only
12 percent of the participants met that goal.

The average daily
consumption at baseline was 3,031 mg, with one-fifth of the cohort ingesting
more than 4,000 mg a day.

Over a mean
follow-up of 10 years, there were 227 strokes.

After adjustment
for demographics and behavioral and vascular risk factors — including hypertension — every 500
mg/day increase in sodium intake was associated with an 18 percent relative
increase in stroke risk compared with people who used less salt.

Those individuals
who consumed the most — more than 4,000 mg/day — had a three-fold increased
risk compared with those who met the AHA target.

“The results of our
study suggest that the new AHA strategic dietary goals will help promote ideal
cardiovascular as well as brain health,” Gardener said, “and this evidence can
be used in campaigns aimed at reducing cardiovascular disease risk by targeting
dietary behavior.”

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